For an article about how hepatitis D virus (HDV) infection significantly worsens liver fibrosis in individuals already infected with hepatitis B virus (HBV):

With new treatments for HDV becoming available, how does this study's emphasis on early detection change the conversation around treatment—and what does the future of managing HDV coinfection look like?

Question

For an article about how hepatitis D virus (HDV) infection significantly worsens liver fibrosis in individuals already infected with hepatitis B virus (HBV):

With new treatments for HDV becoming available, how does this study's emphasis on early detection change the conversation around treatment—and what does the future of managing HDV coinfection look like?

Dr. Gregory Gasic · Accepted Answer

Good Day,

Unfortunately, the study hasn't really told us anything new, although it's a very important message: hepatitis D is a priority in early detection among the hepatitis B patients who happen to be co-infected with HDV. Coinfection with HDV does not lead to mild developments; it literally accelerates the liver damage to an extent that can even result in completely severe problems like cirrhosis much faster than that of mono-infected HBV. Early detection now has an entirely new meaning with treatment options like bulevirtide. Knowing someone has HDV was all we had-needed. Now, we also have to know when to intervene and change the disease trajectory early enough.

From here, it means HDV testing should automatically be incorporated into routine care for all individuals with chronic hepatitis B, but particularly so for those whose liver numbers simply don't add up. Waiting has gone wrong, and the results are based on assumptions. The current plan is to treat patients much earlier than before irreversible damage occurs on the liver. With better testing, earlier intervention, and more treatment options on the horizon, we have a real chance to shift from just managing complications to actually preventing them.

If you decide to use this quote, I'd love to stay connected! Feel free to reach me at gregorygasic@vmedx.com and outreach@vmedx.com.

Seyed Hassan Fakher · Answer

Hello,  I'm Dr. Seyed Hassan Fakher MD, with Invigor Medical. We are a U.S.-based telemedicine clinic specializing in weight loss, longevity, and sexual health. My Clinical focus is on sports medicine, orthopedics wellness and preventive health. I would love to share my expertise and feedback to help you.

In the past, due to reasons like Low disease awareness, Inconsistent screening practices with often only testing HBV patients at high risk, and Limited access to reliable diagnostic tools, HDV has been underdiagnosed for many years, and now it affects millions globally. Today, leading hepatology bodies like AASLD, EASL, and EACS  support universal HDV screening for all HBsAg-positive individuals, not just those at elevated risk, and this is due to the fact that Early identification means patients can benefit from new therapies before the disease advances too far. As of recently, the only treatment option available was pegylated interferon-a (PEG-IFN-a), which is only effective in a minority of patients and has many serious side effects. Now, new therapies like 
Bulevirtide, which is an entry inhibitor It blocks viral entry into hepatocytes, or Lonafarnib, which is a prenylation inhibitor that interferes with HDV assembly. With additional agents like the novel interferon Pegylated interferon-l or REP2139 that targets hepatitis B surface antigen (HBsAg) release, which is essential for HDV assembly, that is still in Trials.
Early HDV diagnosis allows us to initiate these newer, more effective treatments before cirrhosis or hepatic decompensation allowing early-stage patients to benefit from the full spectrum of these agents either as monotherapy or in combination, that should be tailored to disease severity, and by curing HDV earlier, we may significantly reduce progression to cirrhosis, HCC, and liver failure, transforming patient prognoses. Finally, applying universal HDV screening and early detection with treatment, we can help understand and contain the true disease burden, leading to better public health planning and resource allocation.

Please contact me in case you have any additional questions
Dr.fakher@invigormedical.com
Dr.Seyed Hassan Fakher MD

Wayne Lowry · Answer

Early detection transforms HDV care delivery out of the crisis mode, and into a time limited period when treatment is more effective and eligibility increases. The most feasible alteration is the reflex testing of anti-HDV on all samples of HBsAg positivity at the laboratory level. Centers which incorporated reflex testing increased the number of HDV diagnosis by more than two folds, with the diagnosis being done before patients develop cirrhosis that limits treatment options. The advice in the United States continues to rest on risk-based testing, but emerging evidence compellingly supports universal screening to prevent a missed diagnosis. Earlier detection of HDV will allow clinicians to apply entry -inhibitor therapy earlier. Blevirtide Real-world cohorts demonstrate significant virologic and biochemical responses at week 96, and more extended treatment durations are associated with extended undetectability upon discontinuation, an important advance toward long-term control.

The coming years of management will be focused on treat-to-targets practices whereby HDV RNA is assessed at specific time intervals, and combination therapies where entry blockers and RNA-targeted agents currently being tested in late-phase studies are combined. In primary care, it is an easy and high-yield move. Activate reflex anti-HDV of all positive HBsAg, fibrosis stage early, and arrange an appropriate referral. Such a workflow identifies candidates earlier and provides new therapies with the best opportunity to preserve liver function.

Maegan Damugo · Answer

Screenings in early stages shift HDV to a same-visit care pathway instead of a late referral issue. All HBsAg-positive patients with anti-HDV are screened by reflex, followed by HDV RNA screening, anticipating coinfection prior to decompensation, allowing clinicians to stage fibrosis early and providing access to treatment or trials at an early stage. European guidance already advises one-time HDV screening of all HBsAg-positive individuals and initiatives are currently trending toward reflex testing to lower the occurrence of missed diagnoses. Such a shift is important since entry-inhibitor therapy like bulevirtide has demonstrated sustained virologic response in real-world follow up, but is still experimental in the United States. Decisions on intensification or de-escalation are anchored by routine RNA tracking during therapy, frequently every six months.

The management will become more modular. Bulevirtide where possible, HBV suppression and structured monitoring today. Combinations in development are to minimize exposure to interferon and shift towards finite all-oral regimens. They include lonafarnib in combination with ritonavir with or without interferon, peginterferon lambda programs, and combinations of neutralizing antibody with siRNA, which has recently gained FDA fast track. To the patients, earlier diagnoses will progressively mean clear options, less toxicity duration, and management plans geared towards HBV management at an early stage.

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